Ask the Sexpert: Dec. 16, 2010

My friend claims to have gotten an intrauterine device for birth control, but she’s only 19. What’s the deal? I thought IUDs were only for older women.

— Interested in Uterine Devices

Dear Interested,

Intrauterine devices are in the midst of something of an American comeback. Twenty years ago, a teenager with an IUD would have been extremely unusual; today, more and more women, especially younger women, are considering them. For this type of birth control, the road back to the mainstream has been extremely long, but I am very glad to have the opportunity to put some common misconceptions to rest.

Planned Parenthood describes IUDs as “small, ‘T-shaped’ devices made of flexible plastic.” The IUD is inserted in the uterus by a medical professional in a simple outpatient procedure, and it prevents pregnancy by stopping the sperm from meeting the egg, often by thickening mucous on the cervix. Mirena, one of the IUD brands available in the United States, also contains the hormone progestin, which is released into the woman’s body and stops her from ovulating. Both Mirena and ParaGard are more than 99 percent effective and last for a very long time — five years for Mirena, 10 years for ParaGard.

Intrauterine devices first appeared on the market decades ago and were quite popular for a time. However, during the mid-1970s, a very large number of women using a device known as the Dalkon Shield experienced serious health complications. A flaw in the device’s design led to serious infections, and in a flurry of lawsuits and bad press, IUDs lapsed into a limbo state, with few doctors willing to recommend them. By the middle of the 1980s, IUDs had all but disappeared from the birth control roster in the United States.

Thanks to some researchers, we have a very good idea of what the problems with the Dalkon Shield were. Newer IUDs, like the two available in this country (Mirena and ParaGard), have entirely updated designs. They have been tested extensively and were found to pose nowhere near the risks of the Dalkon Shield. In addition to design updates, certain protocols, such as testing women for sexually transmitted infections before inserting the device, are now standard. These improvements have made IUDs very safe. However, the scandal from 30 years ago has proven to have a pretty long shadow. This means that most women who are old enough to remember when IUDs were popular also remember when IUDs were (relatively) dangerous, and most younger women do not think of them as being a viable option simply because they don’t think of them at all. Today, the American College of Obstetricians and Gynecologists and the World Health Organization both approve IUDs for women who have never given birth.

You should talk to your doctor if you think IUDs might be the right type of contraception for you. IUDs are expensive — at least several hundred dollars — but that one large expenditure will cover all your birth control costs for many years and might actually save you money in the long run compared to the pill or other methods. IUDs do not offer any protection against infection, so people whose sex lives put them at greater risk of contracting diseases will not benefit much from an their advantages. They can, however, be used in conjunction with a condom. IUDs can be great for women who don’t enjoy the hassle of a daily pill.

Check the Sexpert page on Facebook for links to Planned Parenthood’s fact sheet on IUDs and Kate Klonick’s superb Slate article on IUDs.

— The Sexpert

The Sexpert is written by a team of peer sexual health educators and fact-checked by University health professionals. You can submit questions to sexpert@dailyprincetonian.com. Don’t be shy!